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What are the 10 principles of care?

Jef Smith muses on the current ten principles of good care that should ensure quality care for all service users. Introduction. ... Privacy. ... Dignity. ... Independence. ... Choice. ... Civil Rights. ... Fulfilment. ... Security. More items... •

app.croneri.co.uk - The principles of good care - Croner-i

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Jef Smith muses on the current ten principles of good care that should ensure quality care for all service users. Introduction If any subscriber to Croner’s classic guide, Care Home Management, had retained a copy from, say, 1990 — against editorial instructions, which advise that to avoid confusion, old sections should be deleted as amendments are inserted — they would find that, a quarter of a century later, the latest version of the book still starts with an Introduction headed “The principles of good care”. Such principles, it might be assumed, are basic, fundamental and surely unchanging, but there are in fact significant differences between the text we originally set out and the contemporary version. The most significant change is that the six original principles have grown to ten. There has been no going back on the importance of privacy, dignity, independence, choice, civil rights and fulfilment — the original six — but their ranks have been swelled by security, diversity, coordination and, most recently, candour. These were not casual additions. On the contrary, each was fully justified by a fresh emphasis on what was recognised as a previously neglected element in the business of caring, so our vision of the optimal service has been progressively broadened. We did not start the list from scratch, far less claim originality for it. In fact, the original six were lifted directly from a Department of Health publication which had appeared in 1989. This was Homes are for Living In, an immensely influential account of what makes for good care and which almost immediately became affectionately known as “Hafli”. In retrospect, it is possible to see that the thinking behind Hafli was well ahead of its time. The quality of care services at that time left much to be desired and the idea that service users had rights of their own which should be respected was by no means universally accepted. The Poor Law, though theoretically abolished some decades earlier, still cast an invidious shadow over social care provision.

Privacy Privacy has always topped the list, but again it is difficult to recall how at that time what now seems a basic right was often little respected. Counsel and Care, the voluntary organisation of which I was then the general manager, published a report in 1991 on the lack of privacy in many care homes in Greater London under the provocative title Not Such Private Places. We found, for example, that 80% of homes expected some residents to share bedrooms, that 20% had no locks on the doors of bathrooms and toilets, and that barely a half offered residents lockable storage space for valuable belongings. Things have certainly changed for the better on issues like those, but the battle to build respect for privacy firmly into the regime of homes is far from completely won. Do staff, for example, invariably knock on the doors of residents’ rooms before entering or — to put the question in a slightly different way — do all residents have the means of making it clear that there are occasions when they do not want to be interrupted in their own space?

Dignity Respect for privacy is often quoted as a prime example of the value a home places on dignity, but dignity went on to earn a prominent place of its own in the pantheon of residents’ rights. The Department of Health Dignity in Care campaign, launched in 2006, ran for several years, including among its initiatives numerous events, conferences, publications and awards. Dignity proved a popular theme for politicians and has long been enshrined in national standards, but examples of a lack of attention to dignity, sometimes amounting to something near abuse, continue to outrage professional and public opinion. Homes still need to ask themselves, for example, whether their residents are invariably helped appropriately with potentially embarrassing personal tasks such as washing and dressing and whether help with hairdressing, manicure and make-up gives every resident the chance to look their best. Independence The duty to promote service user independence also proved attractive to politicians, though here the message has often seemed slightly ambiguous, as the opportunity of becoming more independent sometimes sounded more like pressure to “stand on your own two feet”. Needing care necessarily involves recognising at least some degree of dependence, not necessarily inappropriately since inter-dependence is central to the way the best families and communities operate. Ambivalence, even confusion on this issue, is illustrated by the current statement on the Department of Work and Pensions website that “the Independent Living Fund (ILF) provides money to help disabled people live an independent life in the community rather than in residential care”. While the next line announces that the ILF is now closed to new applicants. The fund is to be replaced in part by a different benefit, but many people with disabilities are convinced that their lifestyles are under threat. Independence, states our definition, “means having opportunities to think, act and take reasonable risks without constant reference to others”. Easier said than done.

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Choice The principle of choice provokes similarly mixed reactions. Extending consumer choice in health and social care has been a priority for governments of all persuasions over recent decades. In particular, there have been efforts to move away from what some see as paternalistic monopoly of state services to the competitive diversity of the private market. However, critics claim that a genuinely liberating range of options in reality exist only for the well-off and well-informed. In the context of residential care, extending choice has involved, for example, a wider range of menus, the abolition of restrictive rules, a greater respect of individuals’ personal preferences, and a general retreat from uniformity. Happily, much of this costs nothing, except for those whose rigidity of attitude precludes service user empowerment and change. Civil Rights The promotion of residents’ civil rights has been relatively little discussed as a general principle, but helping people to participate in political activities, to make use of the full range of public services like libraries and education, and to complain about services they find inadequate are all relevant. The issue of access for residents to primary healthcare on the same terms as other citizens remains unresolved, with many homes still having to pay a premium to get a basic service. In their defence, GPs complain that treating people in homes is uniquely time-consuming. Although this situation remains a concern for well-run homes, only the Department of Health can resolve this dilemma. Fulfilment The rise in the average age of homes’ residents, with the inevitably accompanying morbidity, has made achieving Hafli’s sixth right, fulfilment, increasingly difficult but increasingly more urgent. Helping residents to lead fulfilling lives requires a particularly personal approach to their needs and aspirations, but the greater the disability, the harder it is to retain opportunities to participate in social and cultural activities, to express faith preferences meaningfully, to enjoy simple pleasures such as getting outdoors, travelling, and contacting friends and family, which people without disabilities take for granted. It was encouraging to see that “The Arts” was selected as one of the themes of this year’s Care Homes Open Day. Security Promoting all of the Hafli rights involves striking a balance between the peril to which vulnerable people can be exposed and the reasonable risk-taking which makes life worth living. Homes were inclined to err on the side of over-protection, and perhaps some still do, so to express this delicate balance we added the right to security. Enjoying appropriate security means being protected from clear dangers while still enjoying independence of judgement, and legislation has extended this right even to people with limited capacity. Sadly, in recent times, some of the most serious fears of residents arise from abuse by staff, the worst betrayal of the responsibility of care givers to provide security.

Diversity The increasing variety of the ethnic and cultural backgrounds of people coming into the care system gave rise to the next principle of good care — a sympathetic recognition of diversity. Negatively discriminatory behaviour is formally outlawed but has not been entirely eliminated. The positive promotion, even celebration, of diversity still has some way to go, with implications for tackling prejudice, recruiting staff representative of the local service user group and offering workers training which equips them to provide a sensitive and knowledgeable service. Are Muslim residents, for example, helped to observe Ramadan with as much ease as others celebrate Christmas?

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Co-ordination Co-ordination, the ninth addition to our list of principles, again derives from a mixture of public perception and government policy. As residents age and their conditions become more complex, so the provision of care needs to recognise that fragmented services require careful manipulation and stitching together for best results. Admissions to and discharges from hospitals provide the most visible examples of how uncoordinated services fail to meet needs, but similar issues are presented when homes close, when people move between residential and domiciliary care or when adaptations to a property and therapy for a patient with disabilities need to be timed to coincide. Given the continued organisational separation of health and social care, this remains an area of major challenge. Candour Finally, we added the duty of candour, a need sharply revealed and subsequently pressed by government, when recent investigations of serious poor practice lacked the transparency which justice to the victims demanded. Official guidance now requires care providing organisations to be open and honest with the consumers, welcoming positive and critical comments, investigating the allegations of whistleblowers, treating complaints seriously, and publishing and publicising their policies and procedures on dealing with feedback.

app.croneri.co.uk - The principles of good care - Croner-i

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